Clinical Implications of the STAR*D Trial
This chapter provides a synopsis of the clinically relevant findings derived from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study and selected ancillary studies appended to the primary trial. The chapter describes the participants, their recruitment and treatment, and the study design, primary outcomes, and clinically informative results. In particular, the chapter describes acute phase response and remission rates from each of the five treatment steps which entail antidepressant monotherapies and combinations, and psychotherapy alone or in combination with an antidepressant. In addition, longer-term outcomes beyond the 12 week acute trial are described for each treatment step. The treatment challenges described include patient retention and relapse, and longer-term follow-up. The chapter discusses the use of measurement-based care for delivering high-quality care, describes “treatment-resistant” depression and discusses its implications for clinical practice, and discusses the contributions of STAR*D to patient-oriented research and patient care.
KeywordsDepression Pharmacotherapy Practical clinical trial Sequence treatment alternatives to relieve depression Treatment resistance Treatment steps
The author appreciates the editorial assistance of Jon Kilner and the secretarial and administrative assistance of Corrie Brown.
Dr. Rush has received consulting fees, Akili Inc., Brain Resource Inc., Compass Inc., Curbstone Consultant LLC, Emmes Corp, LivaNova, MindLinc, Sunovion, Taj Medical, Takeda, USA; royalties, Guilford Publications, University of Texas Southwestern Medical Center at Dallas (for the Inventory of Depressive Symptoms and its derivatives); and speaking fees, LivaNova.
US Patent No. 7795033: Methods to Predict the Outcome of Treatment with Antidepressant Medication, Inventors: McMahon FJ, Laje G, Manji H, Rush AJ, Paddock S, Wilson AS
US Patent No. 7906283: Methods to Identify Patients at Risk of Developing Adverse Events During Treatment with Antidepressant Medication, Inventors: McMahon FJ, Laje G, Manji H, Rush AJ, Paddock S
Dr. Jain has no disclosures to report.
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